Comparison of predictive and prognostic risk stratification scores for variceal upper gastrointestinal bleeding: a retrospective cohort analysis in a tertiary center

Aims Several risk stratification scores have been developed for predicting endoscopic treatment or patient survival in non-variceal upper gastrointestinal bleeding (NVUGIB). Our aim was to compare the performance of some previously described scores such as Canada-United Kingdom-Adelaide score (CANUKA), Glasgow-Blatchford score (GBS), HARBINGER score, neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and Rockall (pre-endoscopy and complete) scores in predicting with the following outcomes in patients with variceal upper gastrointestinal bleeding (VUGIB): 30-day mortality, in-hospital mortality, need for interventional radiological procedure, need for RBC transfusion and rebleeding.

Methods Patients undergoing emergency endoscopy for upper GI bleeding at the Department of Emergency Medicine at Semmelweis University between January 1, 2022 and December 31, 2023 were included in a retrospective cohort analysis. Cases with VUGIB were managed according to the ESGE guideline. Statistical methods included ROC analysis, through which we obtained the AUROC values.

Results There were 126 patients with VUGIB (79 males, 47 females, mean age 58). In-hospital rebleeding rate was 7.9% (n=10/126) for VUGIB. Second look endoscopy was performed in 30 cases (23.8%). The indication for second look endoscopy was inadequate index endoscopy in 10 cases, suspicion of re-bleeding in 6 cases, control of endoscopic intervention in 12 cases. The 30-day mortality rate was 23.8% (n=30/126). Due to missing data in 5 patients scoring systems were analyzed in 121 patients. Area under receiver operator characteristic curves (AUROC) for predicting various outcomes were as follows: 30-day mortality (HARBINGER: 0.63, CANUKA:0.75, Rockall (pre-endoscopy): 0.73, Rockall (complete): 0.73, GBS: 0.71, NLR: 0.65, RDW: 0.54); in-hospital mortality (HARBINGER: 0.59, CANUKA: 0.7, Rockall (pre-endoscopy): 0.67, Rockall (complete): 0.67, GBS: 0.65, NLR: 0.63, RDW: 0.56); need for interventional radiological procedure (HARBINGER: 0.62, CANUKA: 0.49, Rockall (pre-endoscopy): 0.56, Rockall (complete): 0.56, GBS: 0.54, NLR: 0.54, RDW: 0.67); need for RBC transfusion (HARBINGER: 0.66, CANUKA: 0.83, Rockall (pre-endoscopy): 0.7, Rockall (complete): 0.7, GBS: 0.78, NLR: 0.65, RDW: 0.63); rebleeding (HARBINGER: 0.45, CANUKA: 0.44, Rockall (pre-endoscopy): 0.42, Rockall (complete): 0.42, GBS: 0.5, NLR: 0.53, RDW: 0.56).

Conclusions Currently available risk stratification scores developed mainly for NVUGIB, when used for VUGIB have a suboptimal performance (AUROC≤0.8) in predicting important clinical outcomes as mortality, rebleeding, need for endoscopic or interventional radiological procedure. CANUKA was clinically effective and superior to other scoring systems in estimating the needfor RBC transfusion. Further prospective studies on larger patient cohorts are needed to further analyze and improve risk stratification scores for VUGIB.

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Artikel online veröffentlicht:
27. März 2025